Association of Lipid Profile in Pregnancy with Preeclampsia, Gestational Diabetes Mellitus, and Preterm Delivery

Abstract

IntroductionDuring the last two trimesters of pregnancy, glucose is spared (for the foetus), while the concentration of fatty acids in plasma increases, which can create complications like preeclampsia, gestational diabetes mellitus (GDM), and preterm delivery.AimTo study the association of serum lipid levels during the second and third trimesters with the development of pregnancy-associated diseases, such as preeclampsia, GDM, and preterm delivery.Methods and MaterialsThe present study was carried out at MGM Hospital, Navi Mumbai, India. Two hundred antenatal cases from October 2012 to October 2014 were enrolled after giving an informed consent. A lipid profile was recorded for each subject and was later accessed. The lipid profile of the subjects having either GDM, preterm, or preeclampsia was further used to find an association with the individual disorders. Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) version 20 (IBM SPSS Statistics, Armonk, NY). All reported p-values are two-tailed, and confidence intervals were calculated at the 95% level.ResultsIn preeclamptic patients, the mean systolic blood pressure was 151.40 mm/Hg and the mean diastolic blood pressure was 74.03 mm/Hg in the third trimester. In preeclamptic patients, the mean serum triglyceride levels in the second trimester were 204.00 mg/dl, while the mean was 243.20 mg/dl in the third trimester. In GDM patients, the mean serum triglyceride was 214.33 mg/dl in the second trimester, while it was 230.50 mg/dl in the third trimester. In patients with preterm, the mean triglycerides levels were 212.83 mg/dl and 240.16 mg/dl in the second and third trimesters, respectively. In preeclamptic patients, the mean serum cholesterol levels in the second trimester were 210 mg/dl, while in the third trimester, the mean was 243.60 mg/dl. In GDM patients, the mean serum cholesterol was 223.50 mg/dl and 242.83 mg/dl in the second and third trimester, respectively. The mean cholesterol levels in patients with preterm in second and third trimesters were 213.33 mg/dl and 243.66 mg/dl, respectively. Out of the total 200 patients, 168 had no complications, while 20 (10%) had preeclampsia, six (3%) had gestational diabetes mellitus, and the other six {3%} had preterm deliveries.ConclusionAn association between maternal early pregnancy triglyceridaemia and the subsequent risk of preeclampsia, gestational diabetes, and preterm deliveries was observed. The occurrence of preeclampsia, gestational diabetes, and preterm deliveries cannot be predicted based on the values of serum cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and very-low-density lipoprotein cholesterol (VLDL-C). Hence, estimation of lipid profile is strongly recommended during pregnancy to prevent the deleterious effect of hyperlipidaemia associated with pregnancy.

Risk Factors for the Prediction of Hyperglycemia during Pregnancy – A Cohort Study from a Brazilian Public Primary Care Center

“…Previous studies by our team in the same population have demonstrated that: a) WC ≥ 88 cm and pre BMI ≥25 Kg/m 2 have optimal Sens/Sp for predicting GDM at GA <24 weeks 25 ; b) overweight (pre BMI ≥ 25 Kg/m 2 ) and obesity (pre BMI ≥ 30 Kg/m 2 ) are risk factors for hyperglycemia in pregnancy (GDM-MGH) 22 ; and c) the proportion of metabolic syndrome markers is associated with hyperglycemia level in women with GDM-MGH 26 . The results of other studies in diverse populations do not differ from ours 11,13,14,16,42,43 . Also in agreement with other reports, we observed that the higher Sp shown by FG, HbA1c and HOMA-IR indicate them as the best predictors for ruling out GDM risk and the need for a diagnostic test 10,13,42,44,45 .…”

<p>The Predictive Ability of Two Triglyceride-Associated Indices for Gestational Diabetes Mellitus and Large for Gestational Age Infant Among Chinese Pregnancies: A Preliminary Cohort Study</p>

“…29 Several studies have found that hypertriglyceridemia, even in early pregnancy, 17 is associated with insulin resistance as well as GDM. [18][19][20][21] Enquobahrie et al found that each 20 mg/dl increase in TG concentration leads to a 10% rise in the risk of GDM. Also, they demonstrated that mothers with TG levels more than 137 mg/dl were 3.5 times more likely to develop GDM.…”

“…16 Increasing evidence has suggested that hypertriglyceridemia, even in early pregnancy, 17 is likely to be associated with insulin resistance, 18,19 as well as GDM. 20,21 In addition, fasting plasma glucose (FPG) at the first prenatal visit is related to glycemic metabolism in the mid-gestational period, as suggested in a previous study. 22 Moreover, a recent study has reported that high FPG or BMI in the first trimester of pregnancy is independently associated with later development of GDM.…”

Evaluation of the efficacy of two doses of vitamin D supplementation on glycemic, lipidemic and oxidative stress biomarkers during pregnancy: a randomized clinical trial

“…We found a significant increase in serum concentrations of lipid profile components including TG, total cholesterol, HDL-C and LDL-C from beginning to the late pregnancy in both groups, but the differences were not significant between groups. During pregnancy along with increasing gestational age the levels of lipid profile increase most probably due to hormonal and metabolic changes as a normal physiologic phenomena [46][47][48][49].…”

“…Nevertheless, the importance of changes of blood lipid metabolism during pregnancy pertains to its potential effect on perinatal morbidity and mortality. It has been reported that dyslipidemia in pregnancy associated with preeclampsia, GDM, preterm delivery and cardiovascular disease in the future [47]. Based on some evidence, vitamin D deficiency during early pregnancy associated with more unfavorable changes of lipid profile [53,54].…”